Most people have a gap under the arch of their foot when they are standing. The arch, the inner part of the foot is slightly raised off the ground. People with flat feet or fallen arches either have no arch, or it is very low.

The feet of people with fallen arches may roll over to the inner side when they are standing or walking, known as overpronation. The feet may point outward.

Some simple devices and exercises can help reduce the discomfort of flat feet.

Most people have a gap under the arch of their foot when they are standing. The arch, the inner part of the foot is slightly raised off the ground. People with flat feet or fallen arches either have no arch, or it is very low.

The feet of people with fallen arches may roll over to the inner side when they are standing or walking, known as overpronation. The feet may point outward.

Some simple devices and exercises can help reduce the discomfort of flat feet.

Who gets flat feet?

In a human foot, there are 26 different bones, held together by 33 joints and over 100 muscles, tendons and ligaments.

The arches give spring to the step and distribute body weight across the feet and legs. The structures of the arches determine how a person walks. They need to be both sturdy and flexible to adapt to various surfaces and stress.

Causes of flat feet include:

• Genetic factors, as flat feet can run in families
• Weak arches, where the foot is visible for example, when sitting, but the foot flattens onto the ground when standing
• Foot or ankle injury
• Arthritis or rheumatoid arthritis
• Damage, dysfunction, or rupture of the posterior tibial tendon
• Nervous system or muscle diseases, such as cerebral palsy, muscular dystrophy, or spina bifida
• Tarsal coalition, where the bones of the foot fuse together in an unusual way, resulting in stiff and flat feet. This is most commonly diagnosed during childhood

People are more likely to develop flat feet if they have obesity or diabetes, or during pregnancy.

Flat feet can develop as people age. Daily use can cause the posterior tibial tendon to weaken. This tendon is the main support structure of the arch of the feet.

The tendon can become inflamed after overuse, known as tendinitis, or be torn. Damage to the tendon may cause the arch shape of the foot to flatten.

Flat feet can happen because of a developmental fault that occurs during childhood, or that develops with age, or after pregnancy.

Some people appear to have a very low arch or no arch without ever experiencing problems. Fallen arches or flat feet only need attention if they lead to discomfort, if they indicate another underlying disorder, or if they can lead to future pain elsewhere in the body.

Flat feet in children

Children and infants often look as if they have flat feet. The arch is usually there, but the feet are still forming. In time, the arch will appear as normal. The extra fat on an infant’s foot may also be hiding the arch.

Having apparently flat feet during early childhood does not mean that the person will always have flat feet.

However, if a child has flat feet because of incorrect bone development or another disease such as spina bifida, the underlying cause will need to be addressed.

Diagnosing flat feet or fallen arches

People with flat feet who do not experience pain or other symptoms do not usually consult a doctor.

However, if any of the following conditions arise, medical advice should be sought:

• The fallen arches, or flat feet, have developed recently
• There is pain in the feet, ankles or lower limbs
• Symptoms do not improve with supportive, well-fitted shoes
• One or both feet are becoming flatter
• The feet feel rigid or stiff, or heavy and unwieldy

Most qualified health care professionals can diagnose flat feet by watching the patient stand and walk, and by examining the feet.

The feet will be observed from the front and back. The patient may be asked to stand on tiptoe while the doctor examines the shape and functioning of each foot.

A doctor will also look at the patient’s medical history.

Treatment, exercises, and complications

Some patients with flat feet may automatically align their limbs in such a way that symptoms never develop. Treatment is not usually required.

If flat feet cause pain, supportive well-fitted shoes can help. Some people find that extra-wide fitting shoes bring relief.

Fitted insoles or orthotics, which are custom-designed arch supports, may relieve pressure from the arch and reduce pain if the feet roll too far inwards. An orthotic only brings benefit while it is in use.

Patients with tendonitis of the posterior tibial tendon may benefit from inserting a wedge along the inside edge of the orthotic. This takes some of the load off the tendon tissue.

Wearing an ankle brace may help patients with posterior tibial tendinitis until the inflammationreduces.

Doctors may advise some patients to rest and avoid activities that may make the foot or feet feel worse until symptoms improve.

A person with arthritis or a ruptured tendon may find relief if they combine the use of an insole with painkillers. If these do not work, surgery may be necessary.

Some children’s bones do not develop properly, resulting in flat feet from birth that may continue into adulthood. In these cases, surgical intervention may be necessary to separate fused bones. This is rare.

If obesity leads to flat feet, losing weight may improve symptoms.

Complications of flat feet or fallen arches

People with other foot, ankle, or lower leg problems may find that flat feet either contribute to them or make symptoms worse.

Examples include:

• Achilles tendinitis
• Arthritis in the ankle or ankles
• Arthritis in the foot or feet
• Bunions
• Hammertoes
• Plantar fasciitis, where pain and inflammation occur in the ligaments in the soles of the feet
• Posterior tibial tendinitis
• Shin splints

As fallen arches can affect the way a person’s body is aligned when standing, walking or running, they can increase the chance of developing pain in the hips, knees or ankles.

Are there exercises for flat feet?

A podiatrist or physical therapist may suggest exercises to reduce or prevent fallen arches.

Heel cord stretching

A tight Achilles tendon encourages the foot to pronate, or roll inwards. Heel cord stretching aims to stretch and lengthen the Achilles tendon and posterior calf muscles.

1. Stand facing a wall, with one hand on the wall around eye level
2. Place the leg that needs stretching around one step behind the other leg, with the heel planted on the ground
3. Bend the knee of the front leg until the stretch is felt in the back leg
4. Hold for 30 seconds, rest for 30 seconds, then repeat nine more times